Thinking Outside the Box: Sedated Removal of an Ingested Fishhook from a Dog’s Stomach
Ashley Magee, DVM, DACVS
Eighties’ TV series secret agent Angus MacGyver could always get himself out of a fix and save the day with his Swiss Army Knife, everyday items, and a bit of creativity. In the DoveLewis ER, pets often get themselves into predicaments that require us to think outside of the box to resolve these issues, as many conditions and scenarios can’t be readily resolved with the textbook recommendations.
A five-year-old mixed breed dog presented on referral for potential endoscopic removal of a recently ingested fishhook. The patient ate the hook which was encased in a hot dog segment (who could blame him?). The clients cut the line off the pole and immediately presented the dog to their primary care DVM who sedated the patient, clamped the end of the line with a hemostat, and referred the dog to our facility for removal of the hook and line.
On presentation, the patient was B.A.R. and mildly sedate. Vital signs were within normal limits. Lateral radiographs of the esophagus and cranial abdomen (figure 1) were taken, which showed the hook and sinker within the gastric lumen, along with a considerable amount of food. Because the amount of ingesta present would both hinder visibility as well as scope maneuverability, immediate endoscopic retrieval was not a viable option. Hospitalization and monitoring overnight, with endoscopy the following day when the stomach was empty, was initially recommended. This plan would incur the added costs of hospitalization, pre-procedural radiographs, and possible continuous overnight sedation to facilitate the patient’s tolerance of having the fishing line attached to the exterior of the mouth. Potential complications associated with this plan included inadvertent dislodging of the tethered oral end of the fishing line and passage of hook and line into the intestine, damage to the mouth, esophagus or gastric mucosa due to irritation from the fishing line, inadvertent lodging of the hook into the gastric wall, or inadvertent passage of the hook into the duodenum while still tethered externally, causing plication and damage to the intestine and requiring surgical intervention.
Figure 1. Lateral radiograph of the esophagus and cranial abdomen.
Due to the potential complications associated with delaying endoscopy until the stomach emptied, a new plan was devised. This plan was a modification of methods that utilize an orogastric tube to assist in both endoscopic and surgical removal of foreign material from the gastric lumen of dogs. This method was successful for non-invasive, immediate, and more economical gastric foreign body removal in a canine patient ingesting fishing line and hook.
The Method
Step 1. The patient was sedated with a combination of dexmedetomidine, butorphanol and propofol at standard doses via IV catheter. A cuffed endotracheal tube was placed to protect the airway. The patient was positioned in RLR on the radiography table.
Step 2. Endoscopic grasping forceps were passed through an orogastric tube and used to grasp a loop at the end of the external fishing line. The hemostat clamping the end of the tube was removed and the line fed through the tube to the far end and re-clamped with the hemostat. The endoscopic forceps was removed.
Step 3. The tube was lubricated, passed into the mouth, and advanced aborally along the fishing line into the stomach. An assistant maintained gentle tension on the line so the tube followed the line similar to a guide wire (figure 2).
Step 4. Serial digital radiographs were used to confirm the tube end and hook were proximate to each other, then the hook was pulled into the lumen of the tube (figure 3). In this case, the hook embedded in the tube edge and could not be completely withdrawn into the lumen of the tube, however with the barb embedded in the plastic, it was not able to engage the stomach or esophagus. The tube and hook were removed, en bloc, without incident (figures 4 and 5). Total procedure time was 30 minutes and total visit cost was under $1,000.00, about 50% less than the average endoscopic procedure.
Figure 2. Orogastric tube along side fishing line.
Figure 3. Fishing hook removed.
Figure 4. Orogastric tube removed.
Figure 5. Patient post procedure.
Conclusion
This case study demonstrates a safe, cost effective, and rapid means to remove fishing line and hook from the stomach of a dog. Equipment needed to perform the procedure include a stomach tube, a long set of forceps or other means to push or pull the fishing line through the tube, digital radiography, and perhaps a bit of ingenuity, MacGyver style!